标题: I Gender Affirming or Affirmation Surgery (GAS) [打印本页] 作者: choi 时间: 5-16-2022 13:57 标题: I Gender Affirming or Affirmation Surgery (GAS) 本帖最后由 choi 于 5-16-2022 14:10 编辑
, formerly known as Gender Reassignment Surgery
(1) Male to Female:
(a) "Penile inversion vaginoplasty (PIV) is the gold standard approach for producing feminized genitalia. Patients undergoing PIV report high rates of satisfaction with outward appearance, and the majority of patients undergoing the procedure are able to have vaginal intercourse and achieve orgasm." El Hawa AAA et al, A Novel Application of Magnetic Resonance Imaging to Surgical Planning of Penile Inversion Vaginoplasty. Plastic and Reconstructive Surgery - Global Open (publisher: American Society of Plastic Surgeons), 9: e3733 (2021).
(b) Last thing (medical outcome) first. I select this article (which is locked behind paywall) because the third and fourth (last) authors (Rachel Bluebond-Langner and Lee C Zhao, respectively) are the protagonists in (2).
Blasdel G et al, Coming Soon: Ability to Orgasm After Gender Affirming Vaginoplasty. Journal of Sexual Medicine, 19: 781 (May 2022) https://pubmed.ncbi.nlm.nih.gov/35337785/
Quote:
"Results: A total of 199 patients underwent surgery from September 2017 to August 2020 [at New York University]. The median time to orgasm was 180 days. 178 patients had completed 1 year or greater of follow-up, and of these patients, 153 (86%) were orgasmic and 25 patients (14%) were not. * * *
"Strengths & limitations [of this study]: This investigation is the first [in medical history?] effort to determine a timeline for the return of orgasmic function after gender-affirming vaginoplasty. * * *
"Conclusion: The majority of patients were orgasmic at their 6-month follow-up appointments, however, patients continued to become newly orgasmic in appreciable numbers more than 1 year after surgery.
(c) surgical procedures:
A picture is worth a thousand words, And that is what I will do.
(i) Saylor L et al, Anatomy of Genital Reaffirmation Surgery (Male-to-Female): Vaginoplasty Using Penile Skin Graft with Scrotal Flaps. Clinical Anatomy, 31: 140 (2017; locked behind pay wall) https://onlinelibrary.wiley.com/doi/abs/10.1002/ca.23015
, whose illustration is attached below.
In step 2, testes are removed (medical term is orchiectomy)
Step 4 views the penis from top, showing urethra 尿道 in corpus spongiosum (ivory-colored) with a yellow stent (to keep the orifice open) inside urethra. The erectile tissue os a penis is composed of two corpora cavernosa (colored maroon; singular: corpos cavernosum, meaning cave-like body; on the back of penis) and one corpus spongiosum.
Step 5 shows a pared-down glans 龟头 (which becomes neoclitoris in Step 6) and shorted unrethra (a woman's irethra is only 4 cm long).
Step 6 also shows: "Neovagina formed inversion of penile tissue flap." Inversion? Skin of the penis is now rolled into a tube, with skin lining the wall of the tue, which will become vagina. In a woman, vagina is interposed between uthrera and rectum 直肠 wereas in a man, nothing is situated between urethra and rectum. So to separate urethra and rectum to insert neovagina, rectum (which is thin in th first place) may be torn.
• orchiectomy (n; from Ancient Greek órkhis "testicle, ovary, orchid" + (English suffix) -ectomy to cut out (from ek out + témnō, to cut)
• Orchidaceae https://en.wikipedia.org/wiki/Orchidaceae
(commonly called the orchid family; section 3 Taxonomy, section 3.3 Etymology)
(ii) Doo FX et al, Gender Affirmation Surgery: A Primer on Imaging Correlates for the Radiologist. American Journal of Radiology, 213: 1194 (2019). https://www.ajronline.org/doi/pdfplus/10.2214/AJR.19.21686
, whose Figure 1 shows before and after: On the southwestern border of the urinary bladder 膀胱 is symphysis pubis 耻骨 连接, represented by a pear. The pared-down glans attached to neorovascular bundle (needed to keep vascular supply and sensation intact) has to curved beneath synphysis pubis . Prostate 前列腺 (which produces the bulk of semen) and seminal vesicles 储精囊 are retained, which will be drained through the new urethra.Some scrotal skin will line vagnal vault, because penis skin may not be enough (in a woman, vagina is about 4 inches long in normal state, but may stretch longer during orgasm).
